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NORTFISTAR DEMOLITION AND REMEDIATION A-2014-184 REVIEWED BY EUNICE FIEREDIA (PG 11 OF 11) <br />This endorsement changes the policy to which it is attached effective on Inception date of the policy unless a different <br />date is indicated below, <br />(The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the po!,cy). <br />This endorsement, effective 12:01 AM 07/01/2015 <br />Issued to NORTHSTAR GROUP SERVICES, INC. <br />By NEW HAMPSHIRE INSURANCE COMPANY <br />Premium INCLUDED <br />forms a part of Policy No. WC 34157306 <br />We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce <br />our right against the person or organization named in the Schedule. This agreement applies only to the extent that you <br />perform work under a written contract that requires you to obtain this agreement from us. <br />This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule, <br />Schedule <br />THE PREMIUM FOR THE ENDORSEMENT IS INCLUDED <br />This form Is not applicable in California, Kentucky, New Hampshire, New Jersey, North Dakota, Ohio, Tennessee, <br />Texas, Utah, of- Washington, <br />t" � , , " <br />[UgURIE11; <br />, rm� <br />Countersigned by <br />Authorized Representative <br />